ご予約前によくお読みください。Please read carefully before reservations.
- 心臓疾患がある方、てんかん、または発作のある方、妊娠中の方は事前にお断りさせていただいております。また、現在何らかの病気がある、治療をしている、服薬している、下記の項目に現在、過去を問わず該当するものがある場合はダイビングのご参加をお断りする若しくは、医師による診断書、承諾書の提出をお願いする場合がございます。事前にご相談、お問い合わせください。ツアー当日、明らかに体調が悪そうに見える方、二日酔いの方、当日アルコールを飲酒した方などはお断りさせていただいております。
喘息・肺結核・肺炎・気胸・重度の鼻炎・重度の花粉症・その他呼吸器系のトラブル・中耳炎・外耳炎・心臓障害・不整脈や動悸・高血圧・狭心症・その他の循環器系のトラブル・糖尿病・てんかん・めまいや意識不明を起こす体質・閉所恐怖症 鼓膜が破れている・その他の耳に関するトラブル・妊娠中・現在、薬を服用している・現在、通院している - ダイビング後すぐに飛行機には乗れません。気圧の変化によって減圧症という病気にかかる恐れがあります。複数回、複数日のダイビングをした場合は、最低でも１８時間は飛行機には乗れませんのでご注意下さい。１回のダイビング後でも最低１２時間は飛行機には乗れませんのでご注意下さい。
This is a statement in which you are informed of some potential risks involved in scuba diving and of the conduct required of you during the scuba training program.
Your signature on this statement is required for you to participate in the scuba training program.
In addition, if your medical condition changes at any time during your scuba programs it is important that you inform your instructor immediately.
Read this statement prior to signing it. You must complete this Medical Statement, which includes the medical questionnaire section, to enroll in the scuba training program.
If you are a minor, you must have this Statement signed by a parent or guardian.
Diving is an exciting and demanding activity.
When performed correctly, applying correct techniques, it is relatively safe. When established safety procedures are not followed, however, there are increased risks.
To scuba dive safely, you should not be extremely overweight or out of condition. Diving can be strenuous under certain conditions.
Your respiratory and circulatory systems must be in good health. All
body air spaces must be normal and healthy. A person with coronary disease, a current cold or congestion, epilepsy, a severe medical problem or who is under the influence of alcohol or drugs must not dive.
If you have asthma, heart disease, other chronic medical conditions or you are taking medications on a regular basis, you should consult your doctor and the instructor before participating in this program, and on a regular basis thereafter upon completion.
You will also learn from the instructor the important safety rules regarding breathing and equalization while scuba diving.
Improper use of scuba equipment can result in serious injury.
You must be thoroughly instructed in its use under direct supervision of a qualified instructor to use it safely.
If you have any additional questions regarding this Medical Statement or the Medical Questionnaire section, review them with your instructor before reservations
Divers Medical Questionnaire
To the Participant:
The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training.
A positive response to a question does not necessarily disqualify you from diving.
A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician prior to engaging in dive activities.
Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES.
If any of these items apply to you, we must request that you consult with a
physician prior to participating in scuba diving. Your instructor will supply you with an RSTC Medical Statement and Guidelines for Recreational Scuba Diver’s Physical Examination to take to your physician.
– Could you be pregnant, or are you attempting to become pregnant?
– Are you presently taking prescription medications? (with the exception of birth control or anti-malarial)
– Are you over 45 years of age and can answer YES to one or more of the following?
– currently smoke a pipe, cigars or cigarettes
– are currently receiving medical care
– have a high cholesterol level
– high blood pressure
– have a family history of heart attack or stroke
– diabetes mellitus, even if controlled by diet alone
Have you ever had or do you currently have…
– Asthma, or wheezing with breathing, or wheezing with exercise?
– Frequent or severe attacks of hayfever or allergy?
– Frequent colds, sinusitis or bronchitis?
– Any form of lung disease?
– Pneumothorax (collapsed lung)?
– Other chest disease or chest surgery?
– Behavioral health, mental or psychological problems (Panic attack, fear of closed or openspaces)?
– Epilepsy, seizures, convulsions or take medications to prevent them?
– Recurring complicated migraine headaches or take medications to prevent them?
– Blackouts or fainting (full/partial loss of consciousness)?
– Frequent or severe suffering from motion sickness (seasick, carsick, etc.)?
– Dysentery or dehydration requiring medical intervention?
– Any dive accidents or decompression sickness?
– Inability to perform moderate exercise (example: walk 1.6 km/one mile within 12 mins.)?
– Head injury with loss of consciousness in the past five years?
– Recurrent back problems?
– Back or spinal surgery?
– Diabetes?
– Back, arm or leg problems following surgery, injury or fracture?
– High blood pressure or take medicine to control blood pressure?
– Heart disease?
– Heart attack?
– Angina, heart surgery or blood vessel surgery?
– Sinus surgery?
– Ear disease or surgery, hearing loss or problems with balance?
– Recurrent ear problems?
– Bleeding or other blood disorders?
– Hernia?
– Ulcers or ulcer surgery ?
– A colostomy or ileostomy?
– Recreational drug use or treatment for, or alcoholism in the past five years?
The information I have provided about my medical history is accurate to the best of my knowledge.
I affirm it is my responsibility to inform my instructor of any and all changes to my medical history at any time during my participation in scuba programs.
I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition, or any changes thereto.